2017.0216 flying lessons - mastery flight training

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FLYING LESSONS for February 16, 2017

FLYING LESSONS uses recent mishap reports to consider what might have contributed to accidents, so you can make better decisions if you face similar circumstances. In almost all cases design characteristics of a specific airplane have little direct bearing on the possible causes of aircraft accidents—but knowing how your airplane’s systems respond can make the difference as a scenario unfolds. So apply these FLYING LESSONS to the specific airplane you fly. Verify all technical information before applying it to your aircraft or operation, with manufacturers’ data and recommendations taking precedence. You are pilot in command, and are ultimately responsible for the decisions you make.

FLYING LESSONS is an independent product of MASTERY FLIGHT TRAINING, INC. www.mastery-flight-training.com

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This week’s LESSONS: Questionable Flying

Near the end of last year I had to print a correction to a previous week’s LESSONS. It was a simple error—I won’t repeat it here; there’s no reason to get my mistake in the ethereal record a second time. In my correction I noted that I had read and re-read the erroneous passage prior to posting, and yet I didn’t detect and correct it before I published the report. I wrote at the time that this is a good example of confirmation bias—in basic terms, seeing what I wanted or thought I would see, instead of what was really in front of me. I was too close to the writing—and this can happen in flying as well. Confirmation bias may be a significant issue in aircraft accident causation, and a major threat to the successful outcome of a flight.

Words have meaning (even in 2017), so let’s get definitions out of the way: Confirmation bias is defined as the tendency to interpret new evidence as confirmation of one's existing beliefs or theories. Writing in Psychology Today, Professor Shahram Heshmat, Ph.D., notes:

Confirmation bias Confirmation bias occurs from the direct influence ofoccurs from the direct influence of desire on beliefs. desire on beliefs. When people When people would like a certain iwould like a certain i dea/concept to be true, they end up believing it to be truedea/concept to be true, they end up believing it to be true . They . They are are motivated by wishful thinkingmotivated by wishful thinking . This error leads the individual to . This error leads the individual to stop gathering stop gathering information when the evidence gathered so far confirms the views (prejudices) one information when the evidence gathered so far confirms the views (prejudices) one would like to be true.would like to be true.

Once we have formed a view, Once we have formed a view, we embrace information that confirms that view while we embrace information that confirms that view while ignoring, or rejecting, information that casts doubt on itignoring, or rejecting, information that casts doubt on it . . Confirmation biasConfirmation bias suggests suggests that we don’t pthat we don’t p erceive circumstances objectively. We pick out those bits of data that make erceive circumstances objectively. We pick out those bits of data that make us feel good because they confirm our prejudices. Thus, we may become prisoners of our us feel good because they confirm our prejudices. Thus, we may become prisoners of our assumptionsassumptions ….….

In sum, In sum, people are prone to believe what they want to believe. Seeking to confipeople are prone to believe what they want to believe. Seeking to confi rm our rm our beliefs comes naturally, while i t feels strong and counterintuitive to look for evidence beliefs comes naturally, while i t feels strong and counterintuitive to look for evidence that contradicts our beliefsthat contradicts our beliefs .. This explains why opinions survive and spread. This explains why opinions survive and spread. Disconfirming instances are far more powerful in establishing truth. DisconfirmatioDisconfirming instances are far more powerful in establishing truth. Disconfirmatio n n would require look for evidence to disprove it .would require look for evidence to disprove it . … … LL ook for instances to prove that you are ook for instances to prove that you are wrongwrong . .

From “What Is Confirmation Bias?” April 23, 2015

See https://www.psychologytoday.com/blog/science-choice/201504/what-is-confirmation-bias


Enough theory and linguistics; let’s take this information with us into the cockpit.

Say you are solo in a very familiar aircraft, approaching a busy but familiar airport. The tower controller clears you to land on Runway 20L at Orange County/John Wayne Airport (KSNA), the shorter and narrower of the two parallel runways, and you correctly read back the landing clearance.

As you near the airport, however, for whatever reason you align yourself with the equal length but even narrower Taxiway C…even though a Boeing 737 with six crew and 110 passengers aboard is stopped on Taxiway L, directly blocking what you think is your assigned runway…the flight was holding short of 20L for your landing.

You see the 737 right in front of you; you even ask the tower if it’s supposed to be there. Still, focused on your landing, you overfly the jetliner…reportedly 125 feet above Taxiway L, according to radar data.

Despite the anomalies you continue and make what you think is a normal landing, on Taxiway C. No one is hurt and there is no damage. Shortly afterward the jetliner takes off, otherwise uneventfully. Reports are filed; media and official investigations begin. Details of this scenario are preliminary, and come from an aircraft insurance industry source. Note: there are what appear to be bogus “ATC recordings” of this incident online that use incorrect runway and flight numbers in the audio. See https://aviation-safety.net/wikibase/wiki.php?id=193603

Before we leave this specific event, here’s what it would look like from above the final approach course. Even in the best conditions the white runway numbers at the beginning of 20L are very hard to see against the light concrete…contrast them with the visibility of the numbers on Runway 20R. Still, the relative size and location of the runways themselves, reinforced by the Boeing 737 sitting across the “arrival” end of Taxiway C, should have been starkly obvious clues that something was just not right.

We’ll let investigators do their work, and not deconstruct this specific incident further until they do. More because of who was involved than because it was a nonetheless extremely serious near collision event, however,


it is on the top of our minds…and illustrates the issue of confirmation bias.

There have been many other examples in recent years, including:

• AirAsia 223 landing in the wrong country after the crew input Flight Management System information incorrectly.

• Southwest 4013, Delta 2845, the Boeing Dreamlifter, and others landing at wrong airports.

• An EVA Boeing 777’s wrong turn after departing LAX, resulting in terrain clearance alerts; and

• Any number of under-reported runway incursions, near midair collisions, altitude busts, descents below assigned or minimum altitudes, and other symptoms of pilot confusion in commercial and private aircraft.

See: https://www.thesun.co.uk/news/1743399/airasia-flight-223-landed-in-the-wrong-country-after-pilots-typing-error-sent-plane-to-melbourne-instead-of-malaysia/ http://www.usatoday.com/story/travel/flights/2014/01/12/plane-lands-wrong-branson-airport/4447699/ http://www.usatoday.com/story/travel/flights/todayinthesky/2016/07/08/delta-flight-mistakenly-lands-wrong-douth-dakota-airport/86879086/ http://www.ainonline.com/aviation-news/2014-01-06/atlas-identifies-causes-747s-landing-wrong-airport http://losangeles.cbslocal.com/2016/12/19/jumbo-jets-low-turn-on-wrong-course-startles-neighborhood/ Seeing what we think we’ll see or hearing what we think we’ll hear, then doing what we think we should do, are common hazards in aviation. One of the advantages of a two-pilot crew, with one pilot flying (“PF”) and the other pilot monitoring (“PM”) is a double-check of actions, indications, and operations to overcome the effects of confirmation bias.

Most of us don’t have this additional layer of vigilance watching what we do (or do not do) in the cockpit. We need to be our own quality control, the PM watching what we do as PF. As difficult as that may sound, there are some fairly simple yet effective techniques we can employ to combat confirmation bias:

• Develop and use standard operating procedures. SOPs include items like consistent power settings, flap settings, airspeeds and (as appropriate) landing gear position; they include how you set up and use navigation and communications radios, GPSs, autopilots and other avionics; and how and when you use checklists. SOPs may at first seem to actually contribute to the likelihood of confirmation bias, because by their nature they provide expectations. The confirmation bias-bashing benefit of SOPs, however, is that by using SOPs many decisions are already made for you; all you have to do is confirm they are having the desired effect. Without having to “make it up as you go,” you are free to focus your surplus mental bandwidth on detecting and overcoming anomalies that, if you were under greater workload, you might not notice.

• Use checklists and cockpit flows. Although these are a category of SOPs, it’s worth extra emphasis to use printed checklists and cockpit flow checks to ensure you have not missed anything. Ironically, the busier you are the more important it is you make time for a printed checklist—because when you’re busy you’ll be more likely to forget something, and at the same time more susceptible to confirmation bias.

See http://cockpitintelligence.blogspot.com/2009/05/some-of-you-are-thinking-what-hecks.html

• Talk aloud. I talk to myself when I fly. Maybe it’s a by-product of flight instructing for so long, but I am constantly voicing things like “one thousand seven hundred for three thousand, one thousand three hundred to go;” “gear down, three green, no red [in transit light]”; “thirty-four gallons of fuel remaining, that’s two hours with a reserve, and I’ll have 22 gallons remaining at destination”; etc. I’ve found that by speaking aloud I increase my ability to “pilot monitor” my pilot-flying actions.


• Confirm navigation. I usually keep my GPS moving map display on either the 35 or 50 miles scale to have a level of detail for en route flying. I use closer scales (usually 20 miles) close to airports. But when I load my flight plan, I’ll zoom out to whatever it takes to see the entire programmed flight. Does it make sense? Is it taking me where I plan to go? Or did I program in an anomaly, either a typographical error on the GPS entry system or a planning error that made it into my filed route (that I’ll need to fix before takeoff)? Scaling out to check, and then zooming in to the departure or en route view, would have prevented the AirAsia 223 event mentioned above.

• Crosscheck altitudes. Look at the arrival airport information and state aloud your planned traffic pattern or approach intercept altitude. Make sure it makes sense and you’ve not fallen into a confirmation bias trap. For example, I instructed the fairly low-time pilot of a Florida-based A36 Bonanza from my home field in Wichita recently. Air work complete, descending into KICT while coupled to the autopilot, the pilot spun 1500 feet into the altitude preselect—the airplane would descend to that height and then level off without additional pilot input. As we continued descending through about 3000 feet I pointed at the numbers on the preselect panel and asked, “What is the significance of 1500 feet?” “I always descend to 1500 feet before final descent into the pattern,” the pilot responded. “That might work in Florida, but the field elevation at Wichita is 1320 feet.” The pilot was certain the altitude preselect was set correctly based on experience, but did not actively work to ensure that setting was appropriate to the current environment.

• Monitor groundspeed and fuel burn. As we’ve discussed many times, fuel exhaustion and starvation events are way too common. Often a pilot plans enough fuel for the flight and thinks that it will be sufficient—but then doesn’t lean the mixture quite as expected, or flies at a different altitude than planned (higher means more high-power climb time; lower in turboprops and jets means vastly increase fuel flow). Or the tailwind is less than expected/headwind more than expected, and the flight takes longer than anticipated. I listened to the pilot of a Beech Sierra once who was detailing his pending lawsuit against the FAA based on getting an incorrect winds aloft forecast (by telephone). His claim was that his ground speed was too low flying down Florida’s east coast, and the fuel he planned for the trip was insufficient to keep him from ditching in the Atlantic—when of course he should have simply landed for more fuel along the way. He expected he had the fuel to make it to destination, when monitoring the ground speed and its impact on fuel burn would have told him otherwise.

• Orient yourself to runways. Most of the airplanes I fly have a Horizontal Situation Indicator (HSI), which is a combination heading indicator and GPS/VOR/ILS navigation display. These come in extremely handy for IFR work, but they also help me orient myself to runways, whether taxiing or coming in to land. If I’m not actively using it for anything else, I’ll dial the HSI course needle so that the arrow points to the runway heading. This makes it very easy to determine if I’m on downwind (the tail of the needle is up, on my heading), if I’m on a 45° entry to the downwind (see figure), or if my heading is perpendicular to the yellow course needle, meaning I’m in a base or crosswind leg. If my direction of flight does not make sense compared to the course needle when I have the runway in sight, maybe I’m lining up on the wrong runway.

(Right) Landing on Runway 18, I have the HSI course needle pointing on runway heading. My downwind course will be in the opposite direction, 360°. My current

heading of about 045° is correct for a 45° entry to the downwind.

Similarly, I align the course needle with the planned runway before I taxi for departure. I can tell at a glance if the runway I see I’m taxiing parallel to is the one I think it is.


Of course, there are several tricks for using geo-referenced charts and taxi diagrams that are even more precise. But just because you have something on a moving map doesn’t mean you can’t back it up here in your primary scan also.

• Brief the arrival. Even if you’re a VFR pilot, look at the airport diagram and orient yourself to the runway you’ll use. If you don’t use IFR charts, or there’s not a diagram available for your departure or destination airport, check it out on GoogleEarth or similar resources. Assume nothing; don’t’ rely solely on memory.

Look for traps like left/right runways and parallel taxiways. Take a close look for hints of common mistake areas. For example, there’s a telling indicator exactly where our “Solo” pilot nearly collided with an airliner. The junction of Taxiway L (where the airline sat), Taxiway C (where the Husky landed) and Runway 20L is identified as a “Hot Spot.” Per the FAA, a Hot Spot is a location on an airport movement area with a history of potential risk of collision or runway incursion, and where heightened attention by pilots and drivers is necessary. The area in question has enough of a known history of potential conflict that the FAA saw fit to specifically identify it as such on the airport diagram. That’s probably something you want to know before you land, taxi or depart from an airport.

See https://www.faa.gov/airports/runway_safety/hotspots/hotspots_list/

• Monitor the runway. On final approach, or lining up for takeoff, make a special effort to confirm the runway in front of you is the one you think it is. Look at the runway numbers. Confirm they match your clearance or, at nontowered airports, your intentions. Crosscheck this against your heading as you align with the runway. This would have saved the 49 who died, and the First Officer who survived with severe injuries, when Comair Flight 5191 attempted takeoff from the wrong runway at Lexington, Kentucky. Look for obstacles in the air around the runway and on the surface itself, including airplanes or vehicles on taxiways near runway entry points.

If anything doesn’t check out, if anything just doesn’t make sense (an airliner blocking the threshold, for instance) or for any reason you find yourself thinking “I have a bad feeling about this,” immediately execute a go-around. You can figure it out the next time around, or you can go to another airport. When you’re cleared to land at a tower-controlled airport, you are already cleared to go around if you need to—you don’t have to ask.

See https://en.wikipedia.org/wiki/Comair_Flight_5191

Just one more thing about the incident that prompted this week’s LESSONS. Much has been made in the press of the fact that the pilot commanding the Husky is 74 years old. The media are harping that this is too old to fly. The reality is that just because you are in your 70s you are not suddenly a “bad pilot.” Similarly, just because you are in your 20s/30s/50s (insert age here—I bet it roughly corresponds to your own age as you read this) you are not necessarily a “good pilot.” However, others are rushing to the pilot’s defense when in fact the effects of age cannot be assumed, nor can they be ruled out either. The same goes for fatigue. The NTSB does not have the resources to investigate the pilot’s sleep habits for three days to a week prior to a crash, but fatigue can be as detrimental as alcohol use…or age…to the ability to command an airplane. You never know until it hits you. And we almost never know after the fact. Aging, fatigue, general health, hydration, hypoxia from prolonged time aloft, stress…any and all of these factors can affect your mental abilities. Reduced mental capacity makes us even more susceptible to confirmation bias.

In flight by reference to instruments we teach the process of scan, interpret, aircraft control. This process is just as descriptive of flying in visual conditions, when you consider that eyes and mind inside the airplane or out, we are constantly taking in (mostly) visual


information, deciding what if anything to do with what we see, and controlling the airplane on the basis of those decisions.

Anything that interferes with the process has bearing on the results. Confirmation bias can cripple the first two stages of this three-stage exercise.

How do you mitigate the risks of confirmation bias?

• Question everything. • Gather information continually. • Support or refute your expectations and decisions with real data from skeptical

observations. • Actively monitor the airplane, the environment and yourself, using an active scan,

interpret, aircraft control technique. • If anything doesn’t look right or doesn’t make sense, get away from the threat (example:

go around) and reset.

Employ healthy skepticism knowing that even the best of us are susceptible to conformation bias. As Professor Heshmat writes, Look for instances to prove that you Look for instances to prove that you are wrongare wrong .. Far from avoiding it or considering it a criticism of your piloting ability, in this context you should strive to be a “question-able” pilot. Comments? Questions? Let us learn from you, at [email protected]

See http://www.pilotworkshop.com/tip/estimating-crosswinds/turner

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Thomas P. Turner, M.S. Aviation Safety Flight Instructor Hall of Fame 2010 National FAA Safety Team Representative of the Year 2008 FAA Central Region CFI of the Year Three-time Master CFI

FLYING LESSONS is ©2017 Mastery Flight Training, Inc. For more information see www.mastery-flight-training.com, or contact [email protected].

2017.0216 flying lessons - mastery flight training

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